Hepatology Review: Portal Hypertension & Ascites

Part three of our liver lecture will focus on portal hypertension and mainly, ascites.

What is Ascites?

Ascites is what we refer to as “third spacing.”  When clients come into the hospital with massive abdomens, it is most likely because of fluid accumulation within the abdominal cavity. But why is there increased fluid inside the abdomen?

Portal Hypertension

Ascites relates back to the scarring of the liver that has caused blockage with portal hypertension; that is if the diagnosed portal hypertension is greater than 10mm/Hg. To measure portal hypertension, doctors would send a small tube down the throat, into the stomach, through the duodenum, and up the portal vein to measure the amount of pressure stressing on the portal vein which caused portal hypertension.

Albumin

So, there’s increased pressure being pushed on the vein and also a decrease in albumin. Albumin levels are usually 3.5 – 5.0; same with potassium. Albumin functions as a water magnet because it attracts water. Albumin also transports drugs and binds heavily with calcium.

The absence of albumin production in the liver will cause calcium levels inside the body to deteriorate, drug transportation within the system will be compromised, and most importantly, water will escape from the vascular spaces because there is are no magnets to pull it inside.

If this happens, there will be increased capillary pressure due to the scarring that is caused by inefficient water absorption into the veins. Thus, water escapes into the third spaces, abdominal cavities, and connective tissues. For this reason, your client will present a huge abdomen.

Medical Management

When your client has ascites, doctors will result in paracentesis. Paracentesis is done by sticking a needle inside the peritoneal cavity and draining the fluid out. Once the needle is inside the abdominal cavity, fluid will be drained into containers. Albumin will then be administered to increase the colloid pressure inside the veins which will cause water to be attracted back into the vascular spaces for “re-vascularization.”

Albumin Side Effects

After giving albumin, there will be significant changes that will happen to your client’s condition.

The client’s blood pressure is going to skyrocket. Because the water magnet has been increased and activated to bring all the fluid back into the veins from the abdominal cavity, the veins are going to swell. Pulses will be strong and bounding. Headaches will also occur because of the increased pressure.

Countering Side Effects

To counter the side effects of giving albumin, excess water must be taken out of the equation. The goal is to get the water or the extra fluid out of the body by administering diuretics.

Diuretics decrease the amount of blood volume. With albumin, water from the third spaces is pulled into the vascular areas resulting in increased dilution but decreased electrolytes; it’s like having so much water but not enough sugar.

So, diuretics like Lasix and hydrochlorothiazide are given to cut down the water supply and make sure that the blood mix is equal. Lasix (furosemide) is the drug of choice due to its ability to push intravenously inside the body.

A Quick Summary

So, we have discussed a couple of noteworthy things about ascites – its causes and management. To review:

1. Ascites is that third spacing.
2. Third spacing is due to portal hypertension that is greater than 10 mm/Hg.
3. The liver, which is mainly affected by portal hypertension caused by scarring, is responsible for the production of albumin.
4. Portal hypertension leads to inefficient albumin production which mainly causes ascites. Ascites is a condition that keeps fluid from going into the vascular areas.
5. Albumin is given to bring water back into the vascular spaces.
6. Diuretics are administered to decrease blood volume and prevent albumin side effects.

Client Education

The main reason why ascites exists is due to a liver problem. Even if all types of measures are given to fix the signs and symptoms, if one does not focus on solving the main problem or replace the liver, the problem will persist.

Help liver clients understand why they are suffering from different liver diseases like the irreversible condition – liver cirrhosis. Treating the signs and symptoms are not enough; there must be long-term solutions to fix the primary problem.

Client education is important. Suggest Alcoholics Anonymous for liver clients who are into deep with their alcohol consumption. Make your clients understand the ill-effects of their actions which can also lead to a variety of health conditions like pancreatitis, esophageal varices, and ascites. By being aware of the toxic effects of alcohol, you are teaching your client how to take care of themselves and lead a healthy lifestyle.

Client education is a primary responsibility of nurses – educate the community with risk factors that are damaging to the liver and its surrounding organs.

In our next lecture, we will be discussing hepatitis and its difference with cirrhosis.

Until next time!